Week 15 Neuro

Question 1

symptoms of serotonin syndrome

Answer 1

Mild - HTN, tachycardia, shivering, tremor, hyperreflexia
Moderate - all + hypothermia, hyperactive bowels, mild agitation
Severe - all+ hyperthermia, dramatic swings in HR/BP, delirium, muscle rigidity

Question 2

how long does it take to see physical improvements with antidepressants?

Answer 2

2 weeks

Question 3

how long does it take to see emotional improvements with antidepressants?

Answer 3

6-8 weeks

Question 4

can you stop antidepressants at any time?

Answer 4

no, need to be tapered off to avoid withdrawal symptoms

Question 5

what should be monitored with antidepressants?

Answer 5

DDI, anticholinergic effects, suicide risk

Question 6

selective serotonin reuptake inhibitor (SSRI) MOA

Answer 6

inhibit reuptake of serotonin in CNS

Question 7

selective serotonin reuptake inhibitor (SSRI) AE

Answer 7

HA, N/V/D, insomnia, sexual side effects

- less anticholinergic and CV effects

Question 8

serotonin/NE reuptake inhibitor (SNRI) MOA

Answer 8

inhibit reuptake of serotonin and NE in CNS

Question 9

serotonin/NE reuptake inhibitor (SNRI) AE

Answer 9

HA, nausea, dry mouth, sweating, sexual dysfunction, insomnia

Question 10

SSRI drugs

Answer 10

Citalopram (Celexa) and Escitalopram (Lexapro)

Question 11

SNRI drugs

Answer 11

Venlafaxine (Effexor) and Duloxetine (Cymbalta)

Question 12

Bupropion MOA

Answer 12

inhibit NE and dopamine reuptake

Question 13

Bupropion AE

Answer 13

HA, nausea, significant insomnia, tremor, dry mouth, decrease appetite
- risk of seizures

Question 14

TCA MOA

Answer 14

inhibit reuptake of serotonin and NE in CNS

Question 15

TCA AE

Answer 15

anticholinergic effects, weight gain, sexual dysfunction, sedation, hypotension
- serious risk of OD - monitor CV

Question 16

MAO inhibitors MOA

Answer 16

increase serotonin, NE and dopamine by inhibiting MAO enzyme

Question 17

MAO AE

Answer 17

OH, weight gain, sexual dysfunction

- high risk for serotonin syndrome

Question 18

Benzos/Xanax MOA

Answer 18

bind BZD receptors on GABA channels to enhance GABA inhibitory effects

Question 19

Benzos/Xanax AE

Answer 19

sedation, ataxia, memory issues

Question 20

Buspar AE

Answer 20

dizziness

Question 21

benefits to buspar over xanax

Answer 21

no risk of abuse, no withdrawal symptoms

Question 22

disadvantages to buspar

Answer 22

dizziness

~ 3 weeks to see improvement, metobilized by CYP 3A4 so potential DDI

Question 23

difference between 1st generation and 2nd generation antipsychotics

Answer 23

FGA - typical, before 1990, neuroleptics due to more frequent neurologic AE
SGA - atypical, after 1990, less extrapyramidal symptoms and tardive dyskinesia

Question 24

FGA MOA

Answer 24

block D2 receptors in mesolimbic tract where excess dopamine may contribute to positive sx

Question 25

SGA MOA

Answer 25

block D2 receptors but less than FGA; more affinity for histamine

Question 26

D2 receptor blockade AE

Answer 26

akathisia, tremor, rigidity, bradykinesia, tardive dyskinesia

Question 27

H1 receptor blockade

Answer 27

sedation, weight gain

Question 28

muscarinic receptor blockade

Answer 28

anticholinergic

Question 29

a1 receptor blockade

Answer 29

hypotension, dizziness, syncope, reflux tachycardia

Question 30

rehab concerns for FGA agents

Answer 30

patient at risk for cardiac abnormalities, tachycardia, arrhythmia

Question 31

rehab concerns for SGA agents

Answer 31

significant weight gain, hyperglycemia, and lipid abnormalities

Question 32

Lithium AE

Answer 32

GI (N/V/D), weight gain, polydipsia (thirsty), polyuria, decrease memory, concentration, CNS issues - toxicity